DDW2012:Factors That Affect the Improvement of Liver Stiffness in Patients With

StephenW

Factors That Affect the Improvement of Liver Stiffness in Patients With Chronic Hepatitis B   Sa1045 |                                                                                                                                    
Oh Sang Kwon, Sunyoung Na, Young Kul Jung, Yun Soo Kim, Joo Hyun Kim                     
Affiliation
Internal Medicine, Gachon University Gil Medical Center, Inchon, Republic of Korea

Abstract:
Backgrounds and Aims: Oral nucleot(s)ide analogues (ONA) improve liver fibrosis in patients with chronic hepatitis B (CHB). Although liver biopsy is a standard tool for evaluation of this improvement, it is an invasive method. In addition, it is difficult to repeat liver biopsy. Transient elastography(TE), a novel noninvasive and repeatable method, is a tool for assessing liver fibrosis quantitatively by measuring liver stiffness (LS) which is well correlated with the histologic stage of fibrosis. This study investigated the factors that affect the improvement of LS in patients with CHB for about 2 years interval.
Patients and Methods: Between April 2007 and August 2011, 156 patients with CHB who underwent TE for mean 25 months interval, were retrospectively enrolled. Forty four patients were excluded due to have hepatocellular carcinoma, hepatitis C coinfection, alanine aminotransferase (ALT) >80 U/L at the time of the first TE exam, and start ONA after the first TE exam. Final 112 patients were investigated for the change of LS. Because there is some difference of interval between the two TEs, the annual change of LS was estimated [(the first LS-the second LS)Í12/interval (months)]. All the patients were grouped according to the estimated annual change of the LS >0 kPa (improved) or ≤0 kPa (aggravated).
Results: Seventy nine patients have been taking ONA before the first TE. The other 33 patients did not take ONA, because they had not indication of antiviral therapy such as low HBV DNA or low ALT levels. Seventy one patients had improvement of LS [improved group, 2.83(0.04 to 23.8) kPa], and 41 patients had aggravation of LS [aggravated group, -2.47(-29 to 0) kPa]. There were no differences in age, gender, liver functions, HBV DNA level, and proportion of liver cirrhosis at the first TE between the two groups. In addition, the proportion of low viral load (HBV DNA <2000 copies/mL) throughout the study period was not different between the two groups. However, the mean LS at the first TE was higher in improved than in aggravated group (13.4±13.2 vs. 7.6±4.7 kPa, p=0.001). The proportion of patients taking ONA was higher in improved than in aggravated group (77.5% vs. 58.5%, p=0.034). The proportion of patients having normal ALT level (<40 U/L) throughout the study period was higher in improved than in aggravated group (54.9% vs. 26.8%, p=0.004). In multivariate analysis, higher LS at the first TE (OR: 1.2, 95% CI: 1.02-1.21, p=0.011), ONA therapy (OR: 2.8, 95% CI: 1.1-7.1, p=0.031), and normal ALT throughout the study period (OR: 3.4, 95% CI: 1.4-8.2, p=0.007) were the independent factors that affect the improvement of LS.
Conclusions: Antiviral therapy or maintained normal ALT level improve LS in patients with CHB. However, further study is needed to investigate whether these results match the liver histologic study.

Disclosure(s):
The following people have nothing to disclose: Oh Sang Kwon, Sunyoung Na, Young Kul Jung, Yun Soo Kim, Joo Hyun Kim

StephenW

因素影响慢性乙型肝炎Sa1045患者的肝脏硬度改善吴尚权，Sunyoung娜，荣扬库尔，云Soo Kim表示，宙铉金


内科，Gachon吉尔大学医学中心，仁川，大韩民国

摘要：

背景和目的：口腔nucleot（S）IDE类似物（ONA）改善慢性乙型肝炎（CHB）患者肝纤维化。虽然肝活检是评价这种改善的一个标准工具，它是一种侵入性的方法。此外，它是很难重复肝活检。瞬时弹性（TE），一种新型的无创性和可重复的方法，是肝纤维化定量评估肝纤维化的病理阶段，这是与相关的刚度（LS），通过测量工具。本研究的影响因素，改进的LS在慢性乙型肝炎患者约2年的间隔。
患者和方法：2007年4月至2011年8月，156例慢性乙型肝炎患者接受平均25个月的时间间隔TE，进行回顾性登记。 45名患者被排除因肝癌，C型肝炎合并感染，丙氨酸转氨酶（ALT）> 80 U / L，在第一TE考试的时间，并开始开放网络接驳后第一TE考试。 LS的变化，最终112例患者进行了调查。因为有一些差异区间两者之间的跨国企业，年际变化的LS估计（LS  - 第二LS）Í12/interval（月）]。所有患者进行分组，据估计每年变化的LS> 0千帕（改进）或≤0千帕（加重）。
结果：七十名患者已采取之前的第一TE的开放网络接驳。其他33例没有采取开放网络接驳，因为他们没有抗病毒药物治疗，如低HBV DNA或ALT水平低的迹象。七十一患者有改善LS [改进组，2.83（0.04〜23.8）千帕]，41例有加重的LS [加重组，-2.47（-29至0）千帕]。有没有不同年龄，性别，肝功能，HBV DNA水平，肝硬化的比例在两组之间的TE。此外，低病毒载量（HBV DNA <2000拷贝/毫升）的比例在整个研究期间，两组之间没有不同。然而，在第一TE的平均ls是高比在加重组改善（13.4±13.2比7.6±4.7千帕，P = 0.001）。采取开放网络接驳的患者比例较高，比在加重组改善（77.5％比58.5％，P = 0.034）。整个研究期间ALT正常水平（<40）U / L的患者比例较高，在比在加重组改善（54.9％比26.8％，P = 0.004）。在多变量分析，在第一TE（OR：1.2，95％CI：1.02-1.21，P = 0.011）的LS较高，开放网络接驳治疗（或：2.8，95％CI：1.1-7.1，P = 0.031），与正常整个研究期间（3.4，95％CI或1.4-8.2，P = 0.007），ALT的影响改进的LS的独立危险因素。
结论：抗病毒治疗或维持正常的ALT水平，提高LS在慢性乙型肝炎患者。然而，需要进一步研究，以调查这些结果是否匹配的肝组织学研究。

披露（S）：
下面的人有没有透露：润扬库尔荣吴尚权，Sunyoung娜，金洙，金炫珠